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Is your loved one able to keep up with household chores like they used to?
Yes
No
Can your loved one fix things around the house by themselves?
Yes
No
Is your loved one able to mow the lawn and take care of their yard without assistance?
Yes
No
Is your loved one eating three healthy meals a day?
Yes
No
Can your loved one drive themselves to the store, church and other places?
Yes
No
Is climbing stairs becoming more difficult?
Yes
No
Could your loved one care for themselves if they broke a hip or leg?
Yes
No
Does your loved one spend quality time with other people every day?
Yes
No
Can your loved one manage their personal or household responsibilities without depending upon adult children or others for assistance?
Yes
No
Is your loved one happy living by themselves?
Yes
No
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